(Stroke. 1996;27:1274-1282.)
© 1996 American Heart Association, Inc.
Articles |
Clinical Correlates of White Matter Findings on Cranial Magnetic Resonance Imaging of 3301 Elderly People
The Cardiovascular Health Study
the Departments of Neurology (W.T.L.), Epidemiology (W.T.L.), and Biostatistics (A.A.), University of Washington, Seattle; Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); Department of Public Health Sciences, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, NC (G.L.B.); Departments of Radiology (Neuroradiology Division) (N.B.) and Medicine (L.F.), Johns Hopkins University School of Medicine, Baltimore, Md; Departments of Radiology and Neurological Surgery, University of Pittsburgh (Pa) Medical Center (C.A.J.); Respiratory Sciences Center, University of Arizona, Tucson (P.L.E.); and Department of Radiology, New England Medical Center, Boston, Mass (D.O'L.).
Correspondence to W.T. Longstreth, Jr, MD, Department of Neurology, Box 359775, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104-2499. E-mail wl@u.washington.edu.
Background and Purpose Our aim was to identify potential risk factors for and clinical manifestations of white matter findings on cranial MRI in elderly people.
Methods Medicare eligibility lists were used to obtain a representative sample of 5888 community-dwelling people aged 65 years or older. Correlates of white matter findings were sought among 3301 participants who underwent MRI scanning and denied a history of stroke or transient ischemic attack. Participants underwent extensive standardized evaluations at baseline and on follow-up, including standard questionnaires, physical examination, multiple blood tests, electrocardiogram, pulmonary function tests, carotid sonography, and M-mode echocardiography. Neuroradiologists graded white matter findings from 0 (none) to 9 (maximal) without clinical information.
Results Many potential risk factors were related to the white matter grade, but in the multivariate model the factors significantly (all P<.01) and independently associated with increased grade were greater age, clinically silent stroke on MRI, higher systolic blood pressure, lower forced expiratory volume in 1 second (FEV1), and income less than $50 000 per year. If excluded, FEV1 was replaced in the model by female sex, history of smoking, and history of physician-diagnosed hypertension at the baseline examination. Many clinical features were correlated with the white matter grade, especially those indicating impaired cognitive and lower extremity function.
Conclusions White matter findings were significantly associated with age, silent stroke, hypertension, FEV1, and income. The white matter findings may not be considered benign because they are associated with impaired cognitive and lower extremity function.
Key Words: aged • cognition • hypertension • magnetic resonance imaging • white matter
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V. Hachinski, C. Iadecola, R. C. Petersen, M. M. Breteler, D. L. Nyenhuis, S. E. Black, W. J. Powers, C. DeCarli, J. G. Merino, R. N. Kalaria, et al. National Institute of Neurological Disorders and Stroke-Canadian Stroke Network Vascular Cognitive Impairment Harmonization Standards Stroke, September 1, 2006; 37(9): 2220 - 2241. [Abstract] [Full Text] [PDF]
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J. S. Elkins, W. T. Longstreth Jr, T. A. Manolio, A. B. Newman, R. A. Bhadelia, and S. C. Johnston Education and the cognitive decline associated with MRI-defined brain infarct Neurology, August 8, 2006; 67(3): 435 - 440. [Abstract] [Full Text] [PDF]
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A. El-Saed, L. H. Kuller, A. B. Newman, O. Lopez, J. Costantino, K. McTigue, M. Cushman, and R. Kronmal Factors Associated With Geographic Variations in Stroke Incidence Among Older Populations in Four US Communities Stroke, August 1, 2006; 37(8): 1980 - 1985. [Abstract] [Full Text] [PDF]
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Y. W. Chen, M. E. Gurol, J. Rosand, A. Viswanathan, S. M. Rakich, T. R. Groover, S. M. Greenberg, and E. E. Smith Progression of white matter lesions and hemorrhages in cerebral amyloid angiopathy. Neurology, July 11, 2006; 67(1): 83 - 87. [Abstract] [Full Text] [PDF]
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X. Guo, L. Pantoni, M. Simoni, D. Gustafson, C. Bengtsson, B. Palmertz, and I. Skoog Midlife Respiratory Function Related to White Matter Lesions and Lacunar Infarcts in Late Life: The Prospective Population Study of Women in Gothenburg, Sweden Stroke, July 1, 2006; 37(7): 1658 - 1662. [Abstract] [Full Text] [PDF]
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M. P. Marks, J. C. Wojak, F. Al-Ali, M. Jayaraman, M. L. Marcellus, J. J. Connors, and H. M. Do Angioplasty for Symptomatic Intracranial Stenosis: Clinical Outcome Stroke, April 1, 2006; 37(4): 1016 - 1020. [Abstract] [Full Text] [PDF]
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D. E. Barnes, G. S. Alexopoulos, O. L. Lopez, J. D. Williamson, and K. Yaffe Depressive symptoms, vascular disease, and mild cognitive impairment: findings from the cardiovascular health study. Arch Gen Psychiatry, March 1, 2006; 63(3): 273 - 279. [Abstract] [Full Text] [PDF]
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E. C.W. van Straaten, F. Fazekas, E. Rostrup, P. Scheltens, R. Schmidt, L. Pantoni, D. Inzitari, G. Waldemar, T. Erkinjuntti, R. Mantyla, et al. Impact of White Matter Hyperintensities Scoring Method on Correlations With Clinical Data: The LADIS Study Stroke, March 1, 2006; 37(3): 836 - 840. [Abstract] [Full Text] [PDF]
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D M J van den Heuvel, V H ten Dam, A J M de Craen, F Admiraal-Behloul, H Olofsen, E L E M Bollen, J Jolles, H M Murray, G J Blauw, R G J Westendorp, et al. Increase in periventricular white matter hyperintensities parallels decline in mental processing speed in a non-demented elderly population J. Neurol. Neurosurg. Psychiatry, February 1, 2006; 77(2): 149 - 153. [Abstract] [Full Text] [PDF]
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J.-M. Lee and H. S. Markus Does the white matter matter in Alzheimer disease and cerebral amyloid angiopathy? Neurology, January 10, 2006; 66(1): 6 - 7. [Full Text] [PDF]
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M. E. Gurol, M. C. Irizarry, E. E. Smith, S. Raju, R. Diaz-Arrastia, T. Bottiglieri, J. Rosand, J. H. Growdon, and S. M. Greenberg Plasma {beta}-amyloid and white matter lesions in AD, MCI, and cerebral amyloid angiopathy Neurology, January 10, 2006; 66(1): 23 - 29. [Abstract] [Full Text] [PDF]
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A. L. DeStefano, L. D. Atwood, J. M. Massaro, N. Heard-Costa, A. Beiser, R. Au, P. A. Wolf, and C. DeCarli Genome-Wide Scan for White Matter Hyperintensity: The Framingham Heart Study Stroke, January 1, 2006; 37(1): 77 - 81. [Abstract] [Full Text] [PDF]
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J. M. Burns, J. A. Church, D. K. Johnson, C. Xiong, D. Marcus, A. F. Fotenos, A. Z. Snyder, J. C. Morris, and R. L. Buckner White Matter Lesions Are Prevalent but Differentially Related With Cognition in Aging and Early Alzheimer Disease Arch Neurol, December 1, 2005; 62(12): 1870 - 1876. [Abstract] [Full Text] [PDF]
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C. Bernick, R. Katz, N. L. Smith, S. Rapp, R. Bhadelia, M. Carlson, L. Kuller, and for the Cardiovascular Health Study Collaborative Statins and cognitive function in the elderly: The Cardiovascular Health Study Neurology, November 8, 2005; 65(9): 1388 - 1394. [Abstract] [Full Text] [PDF]
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R. D. Nebes, B. G. Pollock, C. C. Meltzer, J. A. Saxton, P. R. Houck, E. M. Halligan, and S. T. DeKosky Serum anticholinergic activity, white matter hyperintensities, and cognitive performance Neurology, November 8, 2005; 65(9): 1487 - 1489. [Abstract] [Full Text] [PDF]
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W. Jagust, D. Harvey, D. Mungas, and M. Haan Central Obesity and the Aging Brain Arch Neurol, October 1, 2005; 62(10): 1545 - 1548. [Abstract] [Full Text] [PDF]
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A. D. Murray, R. T. Staff, S. D. Shenkin, I. J. Deary, J. M. Starr, and L. J. Whalley Brain White Matter Hyperintensities: Relative Importance of Vascular Risk Factors in Nondemented Elderly People Radiology, October 1, 2005; 237(1): 251 - 257. [Abstract] [Full Text] [PDF]
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W. M. van der Flier, E. C.W. van Straaten, F. Barkhof, A. Verdelho, S. Madureira, L. Pantoni, D. Inzitari, T. Erkinjuntti, M. Crisby, G. Waldemar, et al. Small Vessel Disease and General Cognitive Function in Nondisabled Elderly: The LADIS Study Stroke, October 1, 2005; 36(10): 2116 - 2120. [Abstract] [Full Text] [PDF]
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A. Elbaz, M. Ripert, B. Tavernier, B. Fevrier, M. Zureik, J. Gariepy, A. Alperovitch, and C. Tzourio Common Carotid Artery Intima-Media Thickness, Carotid Plaques, and Walking Speed Stroke, October 1, 2005; 36(10): 2198 - 2202. [Abstract] [Full Text] [PDF]
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D. S. Knopman, T. H. Mosley, D. J. Catellier, A. R. Sharrett, and for the Atherosclerosis Risk in Communities (ARIC) Cardiovascular risk factors and cerebral atrophy in a middle-aged cohort Neurology, September 27, 2005; 65(6): 876 - 881. [Abstract] [Full Text] [PDF]
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C. Dufouil, J. Chalmers, O. Coskun, V. Besancon, M.-G. Bousser, P. Guillon, S. MacMahon, B. Mazoyer, B. Neal, M. Woodward, et al. Effects of Blood Pressure Lowering on Cerebral White Matter Hyperintensities in Patients With Stroke: The PROGRESS (Perindopril Protection Against Recurrent Stroke Study) Magnetic Resonance Imaging Substudy Circulation, September 13, 2005; 112(11): 1644 - 1650. [Abstract] [Full Text] [PDF]
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H Jokinen, H Kalska, R Mantyla, R Ylikoski, M Hietanen, T Pohjasvaara, M Kaste, and T Erkinjuntti White matter hyperintensities as a predictor of neuropsychological deficits post-stroke J. Neurol. Neurosurg. Psychiatry, September 1, 2005; 76(9): 1229 - 1233. [Abstract] [Full Text] [PDF]
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